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4. BASIC CLINICAL REQUIREMENTS
4. Basic Clinical requirements
4.1. Objectives
The trainee should achieve such knowledge during the training period that she/he after qualification independently or as the responsible surgical member of an interdisciplinary oncology team is able to:
- recognize symptoms and signs of cancer
- make a diagnostic programme for suspected tumours or metastases and perform staging and classification of manifest tumours
- perform prognostic assessment
- define the role of surgery in a given classified disease reflecting the patient’s general condition, including or excluding multimodality approaches in a pre-treatment discussion within a multidisciplinary team
- perform an adequate preoperative work-up
- perform cancer surgery within her/his speciality with high skill and quality
- manage postoperative care
- decide on and perform adequate follow-up
- implement national guidelines into local practice
- perform palliative surgical treatment, supportive and terminal care
- diagnose, score and treat side-effects and complications of surgical treatment
- assess the impact of surgical interventions on quality of life
- communicate accurately and adequately to cancer patients and their relatives
- manage common psychologic reactions to crisis and final stage of life
- practice medicine in accordance with medical ethics and patient’s rights
4.2. Cancer surgery
The trainee in surgical oncology must achieve knowledge and skills in performing complex cancer operations in her/his specialty. The final aim with surgical training is to develop skills in performing RO (radical) resections, adequate diagnostic procedures, lymph node dissections and meaningful palliative procedures. The numbers of operations are not fixed but should be guidance to what is needed to accomplish relevant skills.
A number of 120 cancer operations is recommended. To demonstrate the experience, the trainee has to reach a score of at least 180 points. The following scoring system will be used:
- assist in a major cancer operation – 1 point
- do a major cancer operation – 2 points
- assist a younger surgeon to do a major cancer operation – 3 points
At least half of the 120 operations must be done by the trainee. The operations need to be documented in the trainee’s logbook.
The trainee’s experience should consist of at least one of the following modules:
4.2.1. Melanoma and sarcoma:
| |
Recommended number of operations |
| excision of melanoma |
20
|
| regional node dissection |
20
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| regional perfusion (optional) |
10
|
| surgery of abdominal sarcomas |
10
|
| surgery of trunk and limb sarcomas |
20
|
4.2.2. Gastrointestinal surgery
| |
Recommended number of operations |
| oesophagectomy |
10
|
| gastrectomy with lymph node dissection |
20
|
| Whipple’s pancreaticoduodenectomy |
10
|
| liver resection |
20
|
| colonic resection |
20
|
| rectal resection |
15
|
| palliative procedures |
10
|
4.2.3. Endocrine surgery
| |
Recommended number of operations |
| thyreoidectomy with regional lymphnode dissection |
15
|
| adrenalectomy |
5
|
4.2.4. Breast surgery
| |
Recommended number of operations |
| mastectomy with axillary dissection |
10 |
| breast conserving surgery |
30 |
| sentinel node biopsy for breast cancer |
30 |
4.2.5 Vascular access
| |
Recommended number of operations |
| venous port system |
10
|
4.2.6 Laparoscopic surgery
| |
Recommended number of operations |
| staging laparoscopy for GI cancer |
5 |
| staging laparoscopy for malignant lymphoma |
5 |
| laparoscopic resection of malignant tumours |
10 |
4.2.7 Thoracic surgery
| |
Recommended number of operations |
| pulmonary lobectomy with lymphadenectomy |
20 |
| pneumonectomy with lymphadenectomy |
5 |
| mediastinoscopy |
20 |
| resection of pulmonary lung metastases |
15 |
| thoracoscopic approaches |
10 |
4.2.8 Urologic surgery
| |
Recommended number of operations |
| radical prostatectomy with lymphadenectomy |
30 |
| radical nephrectomy |
15 |
| partial nephrectomy |
10 |
| radical cystectomy with lymphadenectomy |
5 |
| retroperitoneal lymphadenectomy |
10 |
| iliac lymphadenectomy |
10 |
| inguinal lymphadenectomy |
2 |
4.2.9 Gynecologic surgery
| |
Recommended number of operations |
| surgery of endometrial, ovarian and tubal cancer |
30 |
| radical hysterectomy |
15 |
| other pelvic malignancies |
5 |
4.3. Rotations
A surgical oncology trainee is encouraged to spend 2 months each in a department of medical oncology and radiation oncology. The trainee is also recommended to do a rotation to one or more other “modules” in addition to the main interest for at least 6 months in total to broaden her/his experience.
4.4. Conferences
A trainee in surgical oncology should participate in 2 national and one international conference and at least one national or international interdisciplinary oncology workshop.
4.5. Multidisciplinary board participation
The trainee presents at least 30 patients at the regular multidisciplinary board meeting and leads the discussion in decision making.
4.6. Participation in trials
The trainee should:
- submit a study protocol to an ethical committee
- be involved in the start and management of an ongoing oncology trial
- have experience in reporting patients within a trial.
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